Medicare Compliance Consultant

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary

The Medicare Compliance Consultant is a compliance role that supports the compliance program activities and deliverables of a Medicare managed care organization. In partnership with - and under the direction of - the health plan, Medicare Compliance Officer, and other team members, this position will help develop and maintain systems and processes that demonstrate the principles of an effective compliance program and promote compliant and ethical behavior in our Medicare Advantage health plans.Responsibilities include, but are not limited to:

• Maintain an in-depth working knowledge of the health plan's contractual, regulatory, and program policy related obligations as a Medicare Advantage organization.
• In partnership with other senior members of the team, assist with the oversight and monitoring activities used to evaluate the levels of compliance with the Medicare Part C and Part D regulations.
• Provide support for the elements and compliance department responsibilities required under the Medicare Compliance Program, which include (but are not limited to) meeting attendance, capturing meeting minutes, OIG (Office of Inspector General)/GSA (General Services Administration) screening of board members, monitoring compliance mailbox, tracking and assisting responses to compliance inquiries, and serving as a resource to health plan staff.
• Effectively escalate identified risks, concerns, and other issues through appropriate channels.
• Maintain the systems and tools used to track, monitor, review, and communicate Medicare Advantage Part C and D contract deliverables.
• Review, interpret, and distribute regulatory guidance materials, and track required health plan implementation timeframes.
• Support external and internal audit processes in conjunction with senior members of the team; including (but not limited to) project management and tracking of required audit deliverables.
• Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools; maintain system documentation.
• Maintain positive, productive relationships with internal and external constituents to effectively communicate and influence ethical and compliant outcomes.
• Other duties as assigned.

• 2+ years of experience in regulatory compliance in Medicare Advantage Managed Care.

• Previous experience with Medicare Part C and D regulations and Medicare Advantage Managed Care.
• Previous project management experience.
• Previous experience in auditing.
• Strong written and verbal communication skills.
• Detail-oriented.

• Bachelor's degree or equivalent experience (high school diploma or GED + 4 years of relevant experience).

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.